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Understanding and controlling the hazards of surgical smoke.

More than 500,000 workers are exposed to surgical smoke every year; numerous studies have documented dangerous atmospheric agents in surgical smoke causing a range of adverse health symptoms and effects.1,2,3 Hazardous air quality in the operating room has been an occupational concern since the mid 1970s. Research and workplace studies conducted over long periods of time confirm that surgical smoke, also known as surgical plume, contains hazardous substances including respiratory irritants and carcinogens that have been linked to asthma and infectious agents such as human papilloma virus (HPV).4 This article will discuss why the proper use of local exhaust ventilation (LEV) augmented by the use of properly fitted filtering facepiece respirators are the recommended and effective controls to reduce surgical smoke exposures. The composition and exposure hazards associated with surgical smoke depend on a variety of factors such as the type of surgical procedure and device (i.e. laser, electrosurgical, ultrasonic); type and infectious nature of the tissue; extent of tissue ablation; the duration of surgery; and the worker's proximity to the surgical field. The hazards reported to be associated with exposure to surgical smoke are substantiated by the following research evidence.